Creating ContextPalliative Care

for Front-Line Workersin First NationsCommunities

What is Palliative Care?World Health Organization (WHO) Definition of Palliative Care:

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Addresses all of these issues associated with illness and bereavement:• Disease Management• Physical Issues• Psychological & Mental Issues• Social & Practical Issues• Spiritual Issues• Management of the Passing• Loss & Grief

The Philosophy of Palliative Care: (1 of 2)

• It is the individuals right to make informed decisions about their care

• Palliative care strives to meet physical, psychological, social, and spiritual needs of individuals and their families with sensitivity to their personal, cultural, and religious values

• Care should be delivered in a patient-focused, family-centred environment

• It is the individual’s right to access information and services from an educated interdisciplinary team of professionals and volunteers who receive continuing palliative care education

The Philosophy of Palliative Care(2 of 2)

• Palliative care uses a team approach because the help provided is very involved and be carried out by one person.

• The palliative care team is a group of people who work together with a common purpose to help the person.

• Each care provider is a valuable member of the team.

The Medicine Wheel and Palliative Care• All quadrants of the medicine wheel are

interrelated and depend on one another• The four quadrants of the medicine wheel

focus on physical, mental, emotional, and spiritual self

• Medicine wheel focuses on relationships• Palliative care also emphasizes the

relationships between body, mind and soul

Principles of Palliative Care• Access• Equal availability without discrimination • Ethics• Right to information• Right to choice/empowerment• Unit of care

How can palliative care benefit clients, their families, and the staff who care for them?

Studies of individuals receiving palliative care show:• Improved satisfaction with end-of-life care• Improved pain control• Decreased use of hospital transfers, tube

feeding, and physical restraints

Attitudes towards end-of life (EOL)• Attitudes towards passings are influenced by

culture, community, family and past experiences.

• There are unspoken assumptions regarding meaning of health, illness, and passing which may hinder communication.

• Helpers and caregiver must be tolerant of differences and respect the beliefs of others.

Healthcare Providers Attitudes• Our religious/cultural backgrounds influence

our clinical practice• Past experiences may also have profound

influence on how we care for people who are passing

Needs of the Dying (1 of 2)• Physiological good symptom control• Safety a feeling of security• Belonging to be needed

to not feel a burden• Love expressions of affection, contact• Understanding opportunity to discuss dying

explanation about the disease and symptoms

Needs of the dying (2 of 2)• Acceptance regardless of mood and

willingness to socialize• Self-Esteem involvement in decision-

making, especially as physical dependence on

others increases opportunity to give as

well as receive

M. Downing, Medical Care of the Dying, 1989

Priorities may differ but individuals who are dying have similar desires

• To be pain free• To be alert and aware of what is happening• To have the companionship of their family and

friends• To be accepted as the person they have always

been• To maintain their individuality

Priorities may differ but individuals who are dying have similar desires…• Not to die alone • Not to be a burden on their family• To have familiar things around them• To be cared for• To be remembered with love and respect• To have their family continue living and loving

after their deathVanBommel (1989)

Tasks of the dying person• Increased awareness and coping• Preservation and maintenance• Preparation• Coping with anxiety• Coping with losses

Moos & Tsu, 1977; Rando, 1984

From the perspective of anindividual who is dying,some ways to offer support:• Social• Physical• Feelings• Thoughts• Spiritual

Victoria Hospice Society, 1995

How to help…(1 of 2)• Provide time and space for communication• Communicate respect and acceptance of the

dying person• Avoid withdrawing prematurely from the

individual who is dying• Accept that dying may be very difficult

How to help…(2 of 2)• Avoid telling untruths• Provide a holistic assessment and treatment

plan• Communicate your commitment to provide

care for the individual who is dying